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Antibiotics 101Antibiotics 101A review of common infections and their treatment
For others, like
me, who have
a mental block
against all
things related
to antibiotics
Antibiotic BINGO!!
0 Rules:0 I will read a question for each “bingo ball,” if you have the
corresponding phrase on your sheet, answer the question in the box
0 Complete a row, column or diagonal0 All answers must be correct to win the game0 Winner will receive a prize! Woohoo!!
Brief Micro Refresher
Basic Antibiotic CoverageStrep Staph MRSA Entero Gram - Pseudo Anaerobes
(except bacteroides)
Atypicals
Penicillin + - - - - - - -
Ampicillin + +* - + +/- - + -
Amox/clav + + - + + - + -
Vancomycin + + + +/- - - + -
1st ceph + + - - - - - -
2nd ceph + + - - + - - -
3rd ceph + + - - + -* + -
4th ceph + + - - + + + -
Mero/imi + + - +/- + + + -
Pip/tazo + + - +* + + + -
Quinilones +* + - +/- + + +/- +
Azithromycin +/- + - - +/- - + +
Doxycyline +/- +/- +/- * - +/- - + +
TMP-SMX +/- + + - + - - -
Community Acquired Pneumonia
0 Common pathogens:0 S.pneumo, H.flu, moraxella,
chlamydia, legionella, mycoplasma, viruses
0 Empiric treatment:0 Outpatient:
0 Azithromycin 500mg x 1d then 250mg x 4d
0 Doxycycline 100mg BID x 7-10d0 Moxifloxacin 400mg (or levo) x 7d
for pts with co-morbidities 0 Inpatient:
0 Ceftriaxone 1g IV Q24hrs + azithromycin 500mg IV Q24hrs
0 Moxifloxacin 400mg or levofloxacin 750mg IV Q24hrs
0 Duration: 7-10dhttp://www.acutemed.co.uk/diseases/Pneumonia
Healthcare Associated Pneumonia
0 Criteria:0 Hospitalization for two or more
days within the past 90 days0 Current hospitalization > 48hrs
(*HAP)0 Residence in skilled nursing
facility or long term care facility within the last 30 days
0 Receiving outpatient IV therapy within the past 30 days
0 Attending a dialysis center in the last 30 days
0 Home wound care0 Family member with known
MDRP
HCAP Cont’d0 Pathogens:
0 Pseudomonas0 MRSA0 Klebsiella, enterobacter,
acinetobacter, serratia, E.Coli0 Anaerobes (aspiration)
0 Empiric treatment:0 Vitamin P and V0 Piperacillin/tazo OR cefepime
OR meropenem + vancomycin0 Can also consider addition of
gentamicin
Pic 1: http://www.qvision.es/blogs/almudena-valero/2013/04/21/trasplante-de-membrana-amniotica-en-queratitis-aguda-por-pseudomona/Pic 2: http://www.gasdetection.com/Interscan_News/health_news_digest181.html
COPD Exacerbation0 Most common pathogens:
0 H.flu0 Moraxella0 Strep pneumo0 Viruses: parainfluenza, flu,
rhinovirus, RSV
0 Antibiotics:0 Azithromycin (Z-pack)0 Doxycycline 100mg BID x 10d0 Amoxicillin 500-875mg TID x
10d
0 Other therapies:0 Prednisone0 Duonebs
http://meded.ucsd.edu/clinicalimg/thorax_tripod.htm
Sinusitis0 Common Pathogens:
0 Viruses: rhinovirus0 S.pneumo0 H.flu
0 Classification:0 Acute: < 4wks0 Subacute: 4-12 wks0 Chronic: > 12wks
http://www.cnn.com/2012/02/14/health/antibiotics-not-helpful-sinus-infections/
Sinusitis: Empiric Tx
0 When?0 Persistent symptoms
(>10d) or worsening symptoms at day 7
0 What?0 Augmentin 875/125mg
BID0 Amoxicillin 500mg TID 0 Duration: 10-14d
http://4.bp.blogspot.com/_3xJEG7fcX7w/SMS5ECJRwtI/AAAAAAAACBA/v126PDIjCZA/s1600/
Neti+Pot+2.JPG
Cellulitis0 Common pathogens:
0 Strepococcus0 Staphylcoccus
0 Empiric treatment:0 Outpatient:
0 Cephalexin 500mg QID or amoxicillin 500mg TID +/- doxycycline or TMP-SMX
0 Duration: 7-10d0 Inpatient:
0 Vancomycin0 Duration: 7-10d
0 Other therapies: elevation of affected area, +/- steroids
http://en.wikipedia.org/wiki/File:Cellulitis_Left_Leg.JPG
Cellulitis- Diabetics0 Common pathogens:
0 Staph and strep0 Enterobacter0 Enterococcus0 Pseudomonas0 Anaerobes
0 Empiric treatment:0 Augmentin 875mg BID0 Clindamycin 300mg TID0 Amp/sulbactam 3g IV Q6hrs0 +/- vancomycin0 Duration: 5-14d (resolution of
symptoms)
*Important note: bactrim and doxycycline have less strep activity so are not preferred agents
http://healthyliving.blog.ocregister.com/files/2008/10/cellulitis.jpg
Urinary Tract Infection0 Pathogens:
0 Pathogens: E.Coli, E.Coli, E.Coli, Staph saprophyticus, Proteus
0 Uncomplicated:0 Women, no systemic
symptoms (afebrile, no leukocytosis, etc)
0 Complicated:0 Men, indwelling foley,
systemic symptoms0 Pyelonephritis:
0 Flank pain, fever, leukocytosis, +/- WBC casts
http://hsl.uw.edu/files/antibiograms/uw-medicine-2012-antibiogram
UTIs Empiric Treatment0Uncomplicated:
0 Check antiobiograms for resistance patterns0 In Seattle: TMP-SMX = ciprofloxacin BUT nitrofurantoin is
better than all!0 Duration: 3-5d (5d for nitrofurantoin)
0Complicated:0 Cipro or TMP-SMX if mild to moderate illness0 Pip/tazo, cefepime, ceftazidime, carbapenem for severe
illness0 Duration: 7-14 days in general (3-5 days after
defervescence)
0Pyelonephritis:0 Ceftriaxone, ceftazidime, pip/tazo0 Duration: 48hrs IV or until afebrile, then complete total
14d course
Osteomyelitis0Acute vs chronic:
0 Acute: first presentation, symptoms < 2 weeks, absence of necrotic bone
0 Chronic: necrotic bone, > 3 weeks of symptoms
0Pathogens:0 S. Aureus, coag negative staph, strep, enterococcus,
pseudomonas, anaerobes
0Diagnosis:0 Blood culture, bone biopsy culture; wound culture
is generally not helpful
Osteomyelitis
0 Chronic treatment: based on culture results0 Empiric treatment for acute: need to cover anaerobes,
MRSA, pseudomonas0Ampicillin/sulbactam OR pip/tazo OR carbopenem OR
ceftriaxone0AND Vancomycin
0 Duration:0Acute: 4-6 weeks abx (usually minimum 2 weeks IV)0Chronic: 2-6 weeks IV abx then usually addition 6 weeks
with oral therapy (until ESR and CPR normalize)
References
0 Sanford Guide to Antimicrobial Therapy: Sanford Guide Web Edition 2
0 Johns Hopkins Antibiotics Guide, Unbound Medicine iPhone App
0 Cleveland Clinic Guidelines for Antimicrobial Usage 2011-2012